ABSTRACT
Evidence-based patient and consumer health information (EBPI) implies unbiased presentation of the scientific evidence aimed at consumers' informed decision making. A number of consumer information brochures on fall prevention in the elderly have been developed. However, none of these fulfil the criteria of EBPI. It is almost unknown how elderly people respond to EBPI. We performed three focus-group interviews including 19 senior citizens to explore the comprehensibility and acceptance of an EBPI on risk of falling and fall prevention strategies. The analysis of the interviews revealed that the majority of participants did not understand the aim of the brochure, although it was explicitly stated. Most of them had expected concrete instructions on fall-risk management. The numerical and graphical figures and tables displaying fall-risk factors, fall and fracture incidence, and efficacy of the interventions were predominantly judged as confusing and unfamiliar. Beside negative emotional reactions, devaluation, and selective information seeking, a relevant number of participants also appreciated the objective and non-indoctrinating character of the EBPI. Our investigation confirms limited acceptance of EBPI which might predominately be caused by unsatisfied expectations and unfamiliarity with this kind of information.
Subject(s)
Accidental Falls/prevention & control , Evidence-Based Nursing , Focus Groups , Pamphlets , Patient Education as Topic , Aged , Aged, 80 and over , Attitude to Health , Comprehension , Female , Germany , Humans , Male , Middle Aged , Patient Acceptance of Health Care/psychology , Patient SatisfactionABSTRACT
AIMS: Cardiac resynchronization therapy (CRT) has recently emerged as an effective treatment for patients with moderate-to-severe systolic heart failure and left bundle branch block (LBBB). Right ventricular pacing (RVP) leads to an LBBB-like pattern in the electrocardiogram. The aim of this study was to evaluate the frequency of ventricular mechanical dyssynchrony in patients induced by RVP. METHODS AND RESULTS: The study included 33 patients with a conventional single or dual chamber pacemaker, 18 with ejection fraction (EF) > 35% and 15 with EF < or = 35%. In all patients, an intrinsic rhythm without intraventricular conduction delay (QRS < or = 120 ms) was present without RVP. Two-dimensional and Doppler echocardiographic criteria for mechanical dyssynchrony [aortic pre-ejection delay (APE), interventricular mechanical delay (IVMD), delayed activation of the posterior left ventricular wall (PD), septal-to-posterior wall motion delay (SPWMD)] were evaluated in all patients with and without RVP. QRS duration showed no difference between the two EF-groups without RVP (93 +/- 10 vs. 96 +/- 9 ms), but was significantly longer in patients with low EF with RVP (152 +/- 18 vs. 181 +/- 18 ms; P < 0.001). In patients with EF > 35%, only APE was slightly prolonged by RVP (111 +/- 20 vs. 129 +/- 17 ms; P = 0.03), whereas in patients with EF < or = 35% marked pathological differences in APE (118 +/- 29 vs. 169 +/- 24 ms; P < 0.001), IVMD (22 +/- 17 vs. 58 +/- 14 ms; P < 0.001), SPWMD (103 +/- 28 vs. 125 +/- 29 ms; P = 0.004), and PD (-21 +/- 25 vs. - 39 +/- 25 ms; P = 0.005) were found. A significant correlation between QRS duration and mechanical ventricular dyssynchrony was only found for two echocardiographic parameters (IVMD, APE) with RVP. CONCLUSION: In patients with a conventional pacemaker, mechanical dyssynchrony with RVP was shown exceptionally in patients with preserved or moderately depressed systolic left ventricular (LV) function, but in nearly all patients with severely depressed systolic LV function. These patients might benefit from CRT when frequent RVP is required.
Subject(s)
Pacemaker, Artificial/adverse effects , Stroke Volume/physiology , Ventricular Dysfunction, Left/etiology , Ventricular Function, Right/physiology , Aged , Aged, 80 and over , Echocardiography, Doppler , Electrocardiography , Female , Humans , Male , Middle Aged , Ventricular Dysfunction, Left/physiopathologyABSTRACT
Infections of implantable cardioverter defibrillators (ICD) are severe, potentially life-threatening complications of ICD therapy. In the majority these infections are nosocomial by staphylococci, which become apparent within 0.5 years after implantation. Prophylaxis requires a strictly sterile environment during implantation and perioperative antibiotics. While infection of the ICD pocket is diagnosed clinically, infection of the electrodes must be proven by transesophageal echocardiography and positive blood cultures. Therapeutically, the complete ICD system has to be removed to avoid relapses of infection. Beyond 6 months after implantation, lead extraction might become technically demanding and should be done with a standby of cardiac surgery. Antibiotic treatment has to be started before removal of the system, continued for at least 2 weeks before reimplantation and for another 10 days thereafter. Reimplantation should be done outside the originally infected area.
